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By Jennifer Green, B.S.
|Jennifer Green, NCHPAD Visiting Information Specialist|
Parkinson's disease is a progressive neuromuscular disorder that is typically associated with older individuals. This disease is classically difficult to diagnose, as many of PD's symptoms are the same as those of aging. The main symptoms of Parkinson's disease include difficulty in initiating movements (akinesia) and slowness and difficulty in maintaining movements (bradykinesia). Bradykinesia more often affects movements; however, it can also have an impact on speech and swallowing. Other common symptoms associated with PD include postural instability, which encompasses lack of balance and stooped posture as well as muscle tremors. The severity of symptoms tends to vary from patient to patient; not all individuals with PD experience all symptoms. Seeing as this disease is caused by a lack of the neurotransmitter dopamine, there is a considerable amount of literature indicating that a moderate-intensity exercise program can be beneficial for these patients, due to the increase in dopamine levels that occur in response to exercise.
Margaret is a resident at Villa St. Benedict with Parkinson's disease. Along with my fellow students in the clinical exercise physiology program, I work with her at the performance enhancement center. She experiences some of the primary symptoms of PD, including bradykinesia, increased muscle tone, and postural instability, as well as several secondary symptoms, such as stooped posture and fatigue. In order to create the most effective and enjoyable exercise program for Margaret, we had several goals for ourselves as exercise specialists. We wanted her to maintain and improve flexibility, improve posture, and make overall movement easier while also being enjoyable. Just as in any exercise program, it is important to encompass the three main foundations of a successful fitness plan: stretching, strengthening, and aerobic conditioning. What is important to remember about creating an exercise program for an individual with PD is that most people who are diagnosed with this disease tend to be over age 50 and, therefore, are also experiencing the normal effects of aging. Thus, it is essential to address all of these issues as well when building a successful exercise program.
Our goal for aerobic conditioning was to find a non-stop activity that used the entire body, working the heart and lungs as well as skeletal muscles. We also needed to find an activity that Margaret was comfortable with, since she uses a wheelchair for mobility due to the progression of PD. Our solution was the NuStep recumbent cross-trainer. This machine allows the user to perform both upper- and lower-body movement simultaneously and promotes functional fitness. Margaret was able to transfer on and off this machine safely with the use of a gait belt and the assistance of students, and it provided her with a cardiovascular workout that was both comfortable and effective.
Strength training is also another important part of any exercise program, especially for individuals with Parkinson's disease. In individuals with PD, strength training can not only help improve posture and stability but also help develop bone strength, decreasing the risk of fracture. When developing the strength portion of Margaret's exercise program, we wanted to strengthen all muscles, yet focus mainly on the muscles used in activities of daily living (ADL). We wanted to target major muscles such as the biceps, triceps, quadriceps, and hamstrings that assist her in such movements as transfers. In order to do so, we used light free weights and ankle weights, performing higher repetitions versus higher weight as well as performing movements that used Margaret's bodyweight as the resistance, such as chair stands. It's important to remember, especially during strength training, that many patients with PD tend to become fatigued easily and, therefore, it's imperative that you listen and communicate with your client and adapt to his or her level of energy.
Stretching is another component of an exercise program that is important in clients with PD. Stretching combats rigidity, which is a primary symptom of PD, as well as increases flexibility, which can help in everyday movements. It can also help in improving range of motion, posture, and circulation and release muscle tension. For Margaret's program, we used stability balls as well as traditional stretches, making sure to stretch most muscles but still focusing on the ones needed for ADL. In people with Parkinson's disease, stretching should be done everyday to combat not only symptoms of PD but also aging, so it is important to remind your client to do so not only before and after exercise, but every day.
While aerobic conditioning, strength training, and stretching are all important factors that contribute to an effective exercise prescription, other components such as balance are important to work on in individuals with Parkinson's disease. Postural instability is one of the main symptoms of PD and it can be beneficial to your clients to add several exercises focusing on it to their fitness routines. For Margaret's program, we included bonus activities to help with her instability, retropulsion (when patients have a backward lean and have a tendency to step backwards) and shuffling which are all present as a result of the PD. We used Airex balance pads in order to create an instable standing surface. To improve her balance, Margaret performed such movements as standing on one leg while closing her eyes and the Rhomberg stance where one foot is placed directly in front of the other, heel touching the toe. Fitness steps were also used so Margaret could practice picking up her feet as opposed to shuffling. For safety reasons, Margaret would always be wearing a gait belt during these exercises; in addition, the exercise specialist working with her would be close. Finally, Margaret would walk the hallway with a walker, which allowed her to fight her way through a 'freeze' which is a temporary, involuntary inability to move that is fairly common among persons with advanced Parkinson's disease.
Margaret's experience working through an exercise program has been rewarding for both her and the individuals who work with her. When attending her sessions regularly, she says she feels stronger and more confident in her balance and walking patterns. When creating an exercise program for special populations, it is important to not only include exercises that would accompany a traditional fitness program but also to incorporate extra training that will help combat symptoms that are associated with their specific condition. Exercise, while not a cure for Parkinson's disease, should always be part of managing PD. It can help your clients stay ahead of the changes that take place in their bodies and help them feel more in control of their condition.
Cianci, H. (2006). Parkinson's disease: Fitness counts. Miami, FL: National Parkinson Foundation.
Crizzle, A. M. M., & Newhouse, I. J. P. (2006). Is physical exercise beneficial for persons with Parkinson's Disease? Clinical Journal of Sports Medicine, 16(5), 422.
What is Parkinson's Disease? (2009). Retrieved November 30, 2009, from http://www.pdf.org/en/symptoms.
Please send any questions or comments to Jennifer Green at Jennifer Green.